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Alopecia Totalis and Alopecia Universalis – the more extreme iterations of the autoimmune disorder Alopecia Areata currently have little recourse in respect to treatments or therapies with a high success rate. Whilst some options exist, they tend to produce less than stellar results.

Although no hair loss solution has been clinically-proven to treat the mild form of Alopecia, which causes patchy bald spots to the scalp only – compared to the baldness induced by its more severe phenotypes – unlike the others, normal hair regrowth tends to resume naturally within 12 months in many cases. Furthermore, Alopecia Areata treatment for this basic form generally have a higher chance of accelerating hair growth.

Diagram Belgravia Centre Different Types of Alopecia Areata autoimmune hair loss
Areas affected by hair loss shown in blue

Given how obvious these conditions are to others – with Totalis causing baldness of the head, and Universalis leading to the head and body rejecting all hair – they can have significant psychological effects on those affected, whether men, women or children.

It is for this reason, America’s answer to the UK’s MHRA – the Food and Drug Administration (FDA) – is lending its weight to the accelerated development of certain promising treatments for all forms of Alopecia Areata.

One of these is Concert Pharmaceuticals, CTP-543 – an oral JAK inhibitor drug to which it has granted Fast Track status.

Optimal CTP-543 dosage for hair regrowth now established

During the European Academy of Dermatology and Venereology (EADV) Congress in October 2019, representatives for Concert Pharmaceuticals gave an update from the on-going clinical trials into treating all forms of Alopecia Areata with CTP-543.

Data presented at the Madrid event went into more detail regarding the company’s last update and showed that researchers had managed to achieve a 50 per cent relative reduction in Severity of Alopecia Tool score in patients at 24 weeks. These participants had at least 50 per cent hair loss of the scalp prior to starting their allotted medication.

The team had been investigating various dosages of CTP-543 in order to establish the optimum, during double-blind, randomised, placebo-controlled trials with adult participants. The contenders – 4mg, 8 mg or 12 mg – were all taken twice per day for the 24 week study duration.

By the end of the study, there were some impressive results for the higher doses. Whilst 21 per cent of the 4mg group saw their SALT score improve by a minimum of 50 per cent, almost half of all patients in the 8mg group (47 per cent) and just under two-thirds of patients in the 12mg group (58 per cent) achieved this. In contrast, 9 per cent of participants in the placebo group achieved the same.

For those patients who responded to the treatment, the two larger dosages also boasted average SALT score improvements of 78 per cent in the 8mg group and 86 per cent in 12mg group.

Patient Global Impression of Improvement surveys echoed these findings, with 58 per cent of patients taking the 8mg of CTP-543 twice-daily and 78 per cent of those in the 12mg group noting they believed their hairloss to be either “much improved” or “very much improved” at the 24 week endpoint.

James V. Cassella, PhD, the study author and chief development author at Concert Pharmaceuticals – who advised that, in addition to being effective, the drug had been found to be tolerable at all these doses – told the Healio Dermatology journal, “I believe we are seeing the strongest effect of a JAK inhibitor on alopecia areata reported to date, based on the magnitude of effect that we see and the time courses of these doses. Especially with the 12-mg twice daily dosing... With this, given the players in the space, I think it sets a new bar for clinical efficacy in treating alopecia areata.”

Update on baricitinib JAK inhibitor trials

This news follows an announcement from pharmaceutical company, Eli Lilly and Company, which recently advised it has ‘reached a milestone’ in its testing of drug LY3009104, also known as the JAK inhibitor baricitinib, for the treatment of mild to severe forms of Alopecia Areata.

Exploratory trials into using baricitinib to treat patchy hair loss to total baldness caused by the various types of Alopecia Areata, have been underway since at least 2015. They are now entering Phase 3 testing for the treatment of both adults and children.

One aspect it is likely the Lilly team is working on, is reducing the current adverse events profile of baricitinib (brand name: Olumiant), as it carries some pretty serious potential side effect warnings at present in its use as a rheumatoid arthritis medication.

what is an autoimmune disorder information alopecia areata

The patient information leaflet and Olumiant website both state the drug ‘may cause serious side effects.’ These range from ‘serious infections, including tuberculosis (TB)’ and potentially life-threatening ‘blood clots’, to ‘cancer and immune system problems’.

‘Olumiant may increase your risk of lymphoma and other cancers, including skin cancers,’ states the manufacturer’s warning.

Similar serious side effect profile concerns were raised with regard to the JAK inhibitor tofacitnib (brand name: Xeljanz) when that was first discovered to have beneficial hair regrowth effects for people with autoimmune alopecia.

As part of its development, researchers have been exploring topical options of the drug in order to help reduce side effects found in the systemic version.

Interestingly, Incycte, another pharmaceutical company with whom Lilly is currently partnering to investigate baricitinib as an atopic dermatitis treatment, has previously carried out clinical trials into oral baricitinib.

These are the latest updates from the race to develop the first FDA-approved Alopecia Areata, Totalis and Universalis treatments and we will add more information to the Belgravia blog as addtional news is released.

In the meantime, if you are concerned about sudden hair fall, if you are an adult with hair loss from the scalp only, a consultation with hair loss specialist can provide you with a professional diagnosis and personalised treatment recommendations. If you are an adult losing hair from your scalp and/or other parts of your body, including your face, or if you are under 16 years of age, we recommend speaking to your doctor who may then refer you on to a dermatologist.


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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Belgravia specialists are often asked about different scalp or hair oils which may help in the treatment of hair loss.

Those most commonly enquired about include coconut oil, argan oil, castor oil and jojoba oil.

The truth is, there are no hair care products of any type that have been clinically-proven to treat key conditions, such as Male Pattern Baldness, Female Pattern Hair Loss or Alopecia Areata.

So whilst the short answer to whether cosmetic hair and scalp oils can treat hairloss on their own is ‘no’, there are some benefits associated with their use.

Here we look specifically at using jojoba oil as part of a hair regimen.

jojoba oil

What is jojoba oil?

The jojoba plant, also known botanically as simmondsia chinensis, is a dioecious shrub native to Mexico and South Western regions of the USA. It produces seeds rich in jojoba liquid wax ester, commonly known as jojoba oil.

It has a high fatty acid content which comprises a number of different types, predominantly monounsaturated omega 9 and omega 7 oils, including palmitoleic acid, oleic acid, 11-Eicosenoic acid, erucic acid and nervonic acid.

These, particularly oleic acid, are thought to have some metabolic health and cancer prevention benefits when ingested; when applied topically, omega-9 preparations can provide various advantages. These include enhancing the activity of antioxidants, as well as providing softening, hydrating properties. They may also help to protect against signs of environmental damage, skin and hair ageing.

A 2005 clinical study of the anti-inflammatory properties of jojoba liquid wax discovered through animals trials that the substance showed similar levels of efficacy to the prescription drug indomethacin.

As inflammation plays a part in many different hair loss conditions, whilst it may not increase hair growth, treat thinning hair or bald spots, it may be useful as a natural anti-inflammatory.

It may also help to prevent damaged hair and hair breakage, which is where weakened hair snaps along the shaft but the follicle is not affected.

Shown to increase minoxidil absorption

Oleic acid has been shown in some clinical trials, to increase the skin penetration of certain topical medications.

woman applying hair loss solution product hair growth

One such drug, studied in 2018, was the only clinically-proven hair loss treatment currently both MHRA-licensed and FDA-approved for androgenetic alopecia in men and women: high strength minoxidil.

In vitro testing – not human trials – showed significantly improved hair follicle delivery of the researchers’ minoxidil-oleic acid formulation when compared to minoxidil alone.

This does not mean anyone using this particular hair loss solution should start mixing it with jojoba oil – or any other oleic acid-containing oil such as olive oil – however; that would most likely just dilute the medication and reduce its efficacy.

You can, if you wish, apply jojoba oil at least an hour before, or at least an hour after applying minoxidil, as a moisturiser to help keep the scalp in good condition. After all, a healthy scalp is important when it comes to healthy hair growth.

Further studies are needed, including large scale clinical trials including human participants, to ensure the long-term safety, tolerability and efficacy of such a concoction. It does provide hairloss researchers with an interesting springboard from which to potentially develop new hair loss products in the future, though.

For now, for those wanting to add hair oils or scalp oils into their general hair routine, we consider jojoba oil to be a safe choice in the majority of cases, with known benefits whether applied to the lengths and strands as a moisturiser, or directly to the scalp to help reduce any inflammation.


Circ - Belgravia Centre Hair Loss Clinics LondonThe Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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HairlossANSWERS - Click to Submit Your Query to Our Hair Loss Experts

Name: Beatriz

Question: I started to get small bald patches on the left side of my head in 2015. After visiting a dermatologist in 2016 I was diagnosed with pseudopelade de brocq. I was prescribed a liquid steroid solution which I applied once per day. I visited the dermatologist a few months later and they felt the condition was no longer active, and said that it doesn’t generally return?

This has remained the case until a month ago when I felt that I was losing hair again and the areas appeared larger. My hairdresser noticed that around my lower hairline, and at the front of my hair above my forehead was thinner but queried if this was more hormonal hair loss as my hair appears drier at the moment.

What is the timescale of pseudopelade and can it return again once it has cleared up? Also, when I went for a second opinion they told me I had lichen planopilaris – are these conditions similar and are the treatments and outcomes the same?

pseudopelade scarring alopecia
An Example of Pseudopelade

Answer: Hi, Beatriz. Pseudopelade can indeed recur and the duration, or how long it takes before it goes into remission, cannot be predicted.

It tends to present in a way that can resemble footprints in the snow and affects three times as many women as it does men, though little is known about its causes, comings and goings.

Pseudopelade is a form of scarring hair loss, which can destroy the hair follicles, leaving permanent baldness in the affected areas. It is part of a group of conditions collectively known as Cicatricial Alopecia or Alopecia Cicatrisata.

Lichen planopilaris also belongs to this group, and both lichen planopilaris and psedopelade are autoimmune disorders with similar symptoms. Most of those affected by lichen planopilaris – an estimated 60 to 90 per cent of cases – are women.

Examples of hair loss from Lichen Planopilaris - cicatricial alopecia

It is a skin disorder, lichen planus, but is known as lichen planopilaris when it affects hair-bearing areas. Symptoms of the condition include erythema – a redness of the skin around sites of inflammation, scaling and hyperkeratotic plugs (thickened outer layers of the skin).

Although sometimes said to be related to stress, this is largely thought to be more due to stress being detrimental to our general well-being and the body’s healing process, including how it responds to autoimmune disorder medications, than stress being any kind of trigger, unlike in other autoimmune diseases, such as Alopecia Areata.

According to the US Department of Health and Human Services’ Genetic and Rare Disease Information Centre, there “exists some controversy as to whether [pseudopelade de Brocq] is a distinct condition or the common final stage or variant of several different forms of scarring alopecias such as discoid lupus erythematosus (DLE) or lichen planopilaris (LPP). Some have suggested abandoning the use of the term pseudopelade of Brocq while others think that the term should be strictly used to describe patients that follow the pattern of hair loss described by Brocq et al.(i.e., multiple, small, discrete, asymmetrical, smooth, soft, flesh-colored or white patches of hair loss with little, if any, inflammation).”

Often, where there is confusion over the diagnosis, a scalp biopsy is recommended in order to to tell these hair loss conditions apart. As such, you may wish to discuss this option with your dermatologist.

At Belgravia we cannot treat either of these conditions but those who can often do so using medications, such as corticosteroid lotions or scalp injections, to address the underlying condition, rather than providing any type of hairloss solution.

Once the condition has been stable for three years, some surgeons may consider carrying out a hair transplant or even scalp reduction surgery, though this is decided very much on a case-by-case basis. These are both highly-skilled procedures and require specialist experience and training so, if you were to explore either of these options, we would recommend speaking to a respected and qualified expert in this particular surgical field first.

It is worth noting that, even once the condition has been stable for the requisite amount of time, and if you are judged suitable for surgical hair restoration, the procedure still may not be a success.

As before, we recommend discussing your options with one of the dermatologists you mentioned seeing, as they should be able to provide you with further advice on getting a confirmed diagnosis and suitable therapies based on these findings.


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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Gut health is not just a hot wellness trend.

The gastrointestinal tract has long been considered the root of good health in Asian medicine, whilst the Western world only started to show significant medical interest over the past 10 years or so.

This is despite the founder of modern medicine, the Greek physician Hippocrates who died in 370BC, famously stating “all disease begins in the gut”.

Researchers in Spain recently conducted a cross-sectional study to establish whether gut microbiota played a role in the autoimmune disorder, Alopecia Areata. Specifically, they were looking for links to its most severe phenotype, Alopecia Universalis.

stomach gut health

Whereas the mild form of Alopecia Areata presents as patchy hair loss to the scalp only, Alopecia Universalis causes complete baldness from head-to-toe.

All forms can be distressing as the hair growth cycle becomes suspended, resulting in sudden hairloss with the length of time this will remain ‘stuck’ being unpredictable.

There are Alopecia Areata treatments available for the scalp-only type, which will often see spontaneous hair regrowth resume within 12 months, too. However, for the more extensive iterations, including Alopecia Universalis, treatments tend to be less successful and the conditions are generally on-going. There are currently no MHRA-licensed nor FDA-approved treatments for Alopecia Areata, though many are in development.

Although the underlying mechanisms that cause all types of autoimmune alopecia are still unknown, various triggers have been identified. These include sudden shock and trauma, allergies, hormones and a genetic element is also suspected.

Possible bacterial biomarkers

A team comprising researchers from various medical institutions in Madrid, compared the gut health of 15 patients with Alopecia Universalis and 15 healthy control participants.

In the study report published in the Journal of the European Academy of Dermatology and Venereology on 16th August 2019, the methodology is explained: “Gut microbiome of the study subjects was analysed by sequencing the 16SrRNA of stool samples. We searched for bacterial biomarkers of alopecia universalis using the linear discriminant analysis effect size (LEFse) tool.”

Of the 30 subjects, 46.6 per cent were women and 53.4 per cent were male and no statistically significant difference was noted in gut bacteria based on gender.

Normal Hair Growth Cycle versus Hair Growth in Alopecia Areata

However, the team noted that an “enriched presence (LDA SCORE > 2) of Holdemania filiformis, Erysipelotrichacea, Lachnospiraceae, Parabacteroides johnsonii, Clostridiales vadin BB60 group, Bacteroides eggerthii and Parabacteroides distasonis” was seen in the participants with Alopecia Universalis.

Furthermore, they advised that a “predictive model based on the number of bacterial counts of Parabacteroides distasonis and Clostridiales vadin BB60 group correctly predicted disease status in 80% of patients…”

It was concluded that, although this study showed that Alopecia Universalis “does not seem to affect broadly gut microbiota structure” more research was needed as there were a number of bacterial biomarkers found which were associated with the disease and these may be involved in the condition’s pathophysiology. Alternatively, their presence could be used to assist in diagnosing the disorder, which can affect men, women and children of any age, race or hair type.

Novartis looking to revist alopecia areata treatment research?

Pharmaceutical company, Novartis contributed to the financing of this Spanish study. This may indicate that the Swiss multinational is considering revisiting a foray into developing Alopecia Areata hair loss solutions.

In 2015 Novartis started clinical trials into its biological, interleukin-17A-blocking drug, secukinumab – which goes under the brand name Cosentyx – to determine whether it could be a potential treatment for Alopecia Areata.

At present – October 2019 – however, there is no mention of this trial, nor any other research into Alopecia Areata in any of its forms, in the company’s pipeline reports. Should any new information come to light on this, we will publish updates here on the Belgravia blog.

In the meantime, adults concerned about sudden hair fall from the scalp should contact a dermatologist or hair loss specialist, whilst children or those with shedding in other areas of the face or body, should speak to their doctor as a first port of call.


Circ - Belgravia Centre Hair Loss Clinics LondonThe Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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As the evenings start getting darker again, the lack of daylight can leave people feeling tired and more sluggish than normal. However, in some cases, constant fatigue can be a sign of something more significant than the changing of the seasons.

There are a number of medical conditions which involve symptoms of constant tiredness and lethargy, many of which can also lead to hair loss.

Here we explore six of these health issues…

tiredness tired sleep ill health stress

1 Iron-Deficiency Anaemia

Essentially an iron-deficiency which can reduce the amount of oxygen supplied to tissues and organs, anaemia is easily detected via a blood test.

The NHS advises that symptoms of iron-deficiency anaemia can include tiredness and a lack of energy, shortness of breath, heart palpitations and pale skin.

It can affect both men and women and is commonly found in women, particularly during pregnancy or heavy periods.

Treatment involves adding extra iron to the diet, often via a course of high strength prescription supplements, to replace that which is missing and bring your levels back in line.

The type of hairloss this condition can cause is known as Telogen Effluvium; it involves shedding from all over the scalp, with diffuse hair fall affecting around 30 per cent of the head at once. Typically hair regrowth will resume naturally once the underlying cause has been dealt with – in this case, the iron deficiency.

It can last up to six months, though Telogen Effluvium treatment may help to accelerate this process. Should the affected individual also have active genetic hair loss, or the relevant dormant predisposition to Male Pattern Baldness or Female Pattern Hair Loss, these can be exacerbated or prematurely triggered.

2 Pernicious Anaemia

Pernicious anaemia follows much the same pattern and advice as for iron-deficiency anaemia, however, instead of a lack of iron, it relates to a deficiency in vitamin B12 and/or vitamin B9 (folate).

Symptoms include extreme tiredness, pins and needles, a sore and red tongue, mouth ulcers, muscle weakness, disturbed vision, depression and confusion, and memory problems.

This is mostly seen in people who are unable to properly absorb these nutrients – such as those with autoimmune disorders including Alopecia Areata – and, therefore, may unknowingly require higher doses. It is also a potential concern for those with a poor diet and is mostly found in those aged 75 or over.

Again, the hair loss condition that can be triggered during pernicious anaemia is Telogen Effluvium.

Normal Hair Growth Cycle and disrupted Alopecia Areata telogen effluvium diagram

3 Hypothyroidism

Hypothyroidism, also known as an underactive thyroid, can lead to tiredness, weight gain, dry hair and skin, muscle aches, cold sensitivity and feelings of depression.

It is diagnosed via a thyroid function test; this involves having a blood test to measure hormone levels. Although it can affect both men and women it is more common in women and it is possible for children to be born with the condition.

Treatment involves taking levothyroxine, a hormone replacement tablet taken daily to increase thyroxine levels. Hair loss, again in the form of Telogen Effluvium or Chronic Telogen Effluvium, also known as Diffuse Thinning, is a known side effect of this medication.

4 Hyperthyroidism

Hyperthyroidism is where the thyroid is overactive; this can cause nervousness and anxiety, irritability, mood swings, difficulty sleeping, persistent tiredness, swelling in the neck, heart palpitations, itchiness, a sensitivity to heat, thinning hair and weight loss.

According to the NHS, an overactive thyroid is ten times more likely to affect women than men, and is often diagnosed when people are aged 20 to 40 years old.

In addition to hair thinning from Telogen Effluvium or Diffuse Thinning triggered by the underlying illness, treatment for hyperthyroidism may also cause temporary hair loss. An endocrinologist may recommend medication such as carbimazole, propylthouracil or beta blockers, all of which list thinning hair as a potential side effect.

Once the body has adjusted to the medication this shedding should stop and normal hair growth should resume, but if the hairloss persists for longer than a few weeks, professional advice should be sought.

5 Diabetes

Diabetes is a condition that can cause a person’s blood sugar levels to become too high and, whether type 1 or type 2, it has known links to hair loss.

Type 1 diabetes is an autoimmune disorder and, therefore, as people with any existing autoimmune diseases are more prone to developing others, those people with hair loss from Alopecia Areata, Alopecia Totalis or Alopecia Universalis are more likely to develop this insulin-related condition. Conversely, those with type 1 diabetes have a higher chance of developing forms of Alopecia Areata.

The mildest form of Alopecia Areata involves patchy hair loss of the scalp only; this may be temporary – lasting up to 12 months at a time – or may come and go over the years. Alopecia Areata treatment can be helpful for this phenotype, however, for the more severe forms which cause baldness of the head, or from head to toe, a dermatologist’s advice should be taken given treatments for these tend to be hospital-based.

Both type 1 and type 2 diabetes – the more common of the two – are also linked to Telogen Effluvium and Diffuse Thinning. This is because the underlying chronic illness places a strain on the body which then diverts its resources towards maintaining critical functions. This can leave non-vital functions temporarily under-resourced.

In the case of hair growth, this can result in diffuse hair loss until the body is over this stress – usually once the health condition is being properly managed. It is possible for people with diabetes to use hair loss treatment and anyone concerned about on-going shedding may wish to consult a dedicated specialist about their options.

feet sleep

6 Restless Legs Syndrome

Willis-Ekbom disease, more commonly known as restless legs syndrome, is a common issue related to the nervous system. As the name suggests, the main symptom is a constant urge to move the legs, often worsening at night.

It causes a ‘crawling’ sensation from the feet to the thighs and can also involve involuntary jerking of the limbs, including arms, with women being twice as likely to have restless legs syndrome than men.

Thought to be related to how the body processes the chemical dopamine, restless legs syndrome is also thought to have genetic qualities and may be hereditary. It can also present as an additional symptom to iron-deficiency anaemia, pregnancy and kidney failure.

In mild cases it may only present occasionally, whilst for those where it is more severe it may happen daily. When it is so frequent it can have negative consequences for a person’s all-round well-being, largely due to the anxiety and lack of sleep – sometimes leading to insomnia – that it engenders.

This can lead to stress-related hair loss, most likely due to Chronic Telogen Effluvium, as well as dry, thinning hair given healthy hair growth requires good sleep hygiene. However, once the underlying reason for this condition developing has been diagnosed and dealt with, the hair should return to normal.

Frequent lack of sleep is essentially a form of stress, so needs to be properly managed.

Getting enough sleep on a regular basis is important for healthy hair growth, as well as for our overall well-being. Therefore, if you are feeling tired all the time and there’s no immediately obvious cause – looking after small children, noisy neighbours or late-night Netflix binges, for example – it is certainly worthwhile speaking to your GP about your concerns.


Circ - Belgravia Centre Hair Loss Clinics LondonThe Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

Related Stories


Despite the recent termination announcement from Aclaris Therapeutics, one of the three pharmaceutical companies that had been leading the way in the development of JAK inhibitor drugs for the treatment of all forms of Alopecia Areata hair loss, this suite of drugs is still being investigated by a number of other parties.

One of these, the School of Medicine at prestigious American Ivy League institution, Yale University, has released its latest findings from a trial exploring treating severe Alopecia Areata, such as Alopecia Universalis, with Xeljanz and oral minoxidil.

During a small-scale trial, it found this combination of oral hair loss treatments provided varying degrees of hair regrowth for almost all of the 12 patients studied.

Two-thirds experienced 75 per cent hair regrowth

One of the first janus kinase inhibition (JAK inhibition) discoveries relating to the treatment of autoimmune-related hair loss disorders – Alopecia Areata, Totalis and Universalis – was made by the team at Yale and related to Xeljanz.

Xeljanz is the brand name for the JAK inhibiting drug tofacitinib, which is made by Pfizer and is currently authorised to treat conditions including rheumatoid arthritis. It has been being trialled by various companies as a potential alopecia areata hair loss solution – in both oral and topical forms – since approximately 2014.

High strength minoxidil is currently used in its topical form to treat androgenetic alopecia – Male Pattern Baldness and Female Pattern Hair Loss – and is both MHRA-licensed and FDA-approved for this purpose. Its oral form is not authorised as a hair loss treatment though it does have the necessary regulatory sanctions as a treatment for high blood pressure.

Although it has only been approved and licensed for genetic hair loss, topical minoxidil is known to have various off-label applications for other hair loss conditions, including as an Alopecia Areata treatment when the condition affects the scalp only. Oral minoxidil is not widely recommended nor used to treat hair loss.

According to research published on 18th September 2019 in the Journal of the American Academy of Dermatology, and covered in the Healio Dermatology publication, 12 adults – 7 women, 5 men – were involved in this latest trial. It looked at results achieved over a period of at least six months.

Each had extensive scalp hair loss that was assessed prior to commencing treatment, and allocated a Severity of Alopecia Tool score which could then be compared to their scores at various intervals during the trial. Baseline hairloss levels were recorded as a median score of 99.5% across all trial participants, meaning they were all almost entirely bald.

The following results were noted by researchers, though the precise timeline for each is not yet available:

– 8 out of the 12 patients achieved 75 per cent hair regrowth to their scalp, represented by a SALT score of 75;

– 4 out of the 12 patients received a SALT score of between 11 and 74, meaning they saw scalp hair regrowth improvements of between 11 and 74 per cent.

Initial dosing involved all male patients being administered a Xeljanz 5mg tablet once each day and 2.5mg of oral minoxidil twice per day; all female patients were given a 5mg Xeljanz tablet once a day and 2.5mg of oral minoxidil once per day in order to minimise the potential for hypertrichosis – the development of excessive or unusual hair growth, such as facial hair.

However, of the eight patients observed to reach a SALT 75 score, seven used tofacitinib (Xeljanz) 5 mg twice per day and the eighth candidate in this result group had their Xeljanz dose increased to 10 mg twice per day after not responding to 5 mg twice daily over the 4 to 6 month period.

“Emerging as an important therapy for severe alopecia”

Tofacitinib (Xeljanz) being trialled as Alopecia Areata Treatment

Although the trial’s overall median final SALT score was 6.5 per cent, the team was keen to stress some significant individual responses and the importance of continuing to explore JAK inhibitors in relation to treating the types of alopecia areata which currently have few safe and effective therapeutic options.

According to Carlos G. Wambier, MD, PhD, of the department of dermatology at Yale and part of the team led by Dr. Brett King, “…one patient who had not achieved any hair regrowth 1 year prior with tofacitinib 11 mg extended release once daily for 3 months, experienced substantial hair regrowth over the first 3 months of combination therapy with the equivalent dose of tofacitinib, 5 mg twice daily…

Janus kinase inhibitors are emerging as an important therapy for severe alopecia areata and the possibility of increasing efficacy without increasing Janus kinase inhibitor dosage (and immunomodulation and cost of treatment) would be welcome.”

The potentially prohibitive cost of Xeljanz, including whether it would be carried by the NHS and covered by insurance companies in America has been an on-going concern since JAK inhibitors were first mentioned as potential Alopecia Areata treatments.

Another troubling factor, which may explain why the Yale team has looked to combining a JAK inhibitor with another hair growth drug, has been the current side effect profile of Xeljanz. Topical versions of the medication have been tested separately in order to help reduce the likelihood of these serious adverse events – ranging from headaches and upper respiratory tract infections, to shingles and an increased risk of tuberculosis – occurring.

As research to produce the first safe, tolerable and effective JAK inhibitor-based hair loss treatments continues, anyone concerned about sudden hair fall from their scalp or other areas of their body are advised to seek professional assistance as soon as possible.

Though a hair loss specialist will generally be able to help adults with the scalp-only form, those losing hair from their body or where they are under 16 years of age shoudl


Circ - Belgravia Centre Hair Loss Clinics LondonThe Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.
HairlossANSWERS - Click to Submit Your Query to Our Hair Loss Experts

Name: Sarah

Question: I am considering starting hair loss treatment with minoxidil but I have a cat and have heard minoxidil is harmful to cats. Please can you advise me if this is true and if there is any way to use it without risking my cat’s health?

Answer: Hi, Sarah. We’ve had several queries regarding high strength minoxidil use and cats over the years.

is minoxidil harmful to cats hair loss treatment advice belgravia centre clinic london

Given it would be unethical to test human hair loss treatment on cats, there is very little reliable scientific research published in medical journals about this.

However, an article from the Journal of Vetinary Emergency and Critical Care, which was published in 2004, reports on the death of two cats following their exposure to topical minoxidil liquid.

The abstract states: “Two cats with dermal exposure to topical minoxidil solution were identified from the ASPCA Animal Poison Control Center (APCC) files. Both cats were presented with lethargy and dyspnea within 36 hours of exposure. The cats were hypothermic, and had pulmonary edema and pleural effusion present on thoracic radiography. Both cats died despite supportive care. Necropsy of both cats confirmed pleural effusion and pulmonary edema and indicated cardiac compromise.”

What this does not tell us is how much minoxidil the cats came into contact with and what strength the hair loss solution was.

At Belgravia we always advise patients, with or without pets, to apply minoxidil at least one hour before they go to bed and to wash their hands their hands thoroughly after each application. This applies to all minoxidil formulations and, by doing so, allows sufficient time for the medication to be absorbed into the scalp with minimal residue.

This is important because any residue on the pillow means that, not only is some of the medication wasted as it is absorbed into the pillowcase rather than the scalp, but, when there is minoxidil residue on the pillow it may come into contact with the patient’s face, increasing the chances of skin irritation or the development of facial hair.

In cases where the patient is a cat owner, we would advise the same – apply at least an hour before going to bed to avoid residue on the pillow. You can also take the extra precaution of changing your pillowcase frequently, even daily, if you wish.

Symptoms of possible minoxidil toxicity in cats which you should be aware of include lethargy, weakness, a rapid respiratory rate, difficulty breathing, a lack of appetite and coughing.

It goes without saying that obviously you should not apply minoxidil to your cat or let it come into contact with your medication. But, should your cat accidentally touch minoxidil, I would advise washing the paw or fur immediately to remove any residue and take them straight to the vet as soon as possible.  

As you no doubt know, cats are very curious and can easily climb onto furniture, getting into even the smallest of spaces, so I would highly recommend storing your hair loss treatment safely, perhaps in a locked cupboard.

You can find further information on this subject, here, and, if you would like further details on women’s hair loss treatment, you may find an online or in-person consultation useful, where can discuss both your shedding concerns and any further queries regarding storage and application of your meds with a dedicated hair loss specialist.


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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On 12th September 2019 it was made official that Aclaris Therapeutics Inc has dropped out of the race to develop the first JAK inhibitor-based treatment for all forms of Alopecia Areata.

The company’s official clinical trial registration for the open label study of its novel topical and oral hair loss solution, known as ATI-502, was updated with the news that it has decided to end its investigations.

This follows disappointing performance reports after ATI-502 Phase 2 trials for each iteration of autoimmune alopecia, from the mild scalp-only form, through to the more extensive Alopecia Totalis and Alopecia Universalis.

Portfolio of exclusive patents

Aclaris has been developing these janus kinase inhibition-based drugs since around 2016, when they announced a ‘strong commitment’ to this particular approach.

Aclaris Therapeutics

The company worked closely with Columbia University in America, which made some of the initial discoveries relating to how JAK inhibitors can be used to treat Alopecia Areata, and acquired many exclusive patent rights to a number of different members of this suite of drugs, licensed from both the Columbia Trustees and others.

What will happen to this impressive portfolio of patents remains to be seen.

Although the company also explored ATI-502 for the treatment of Male Pattern Baldness and Female Pattern Hair Loss, and developed a separate ATI-501 oral candidate for Alopecia Areata, its website suggests these also stalled at the Phase 2 stage.

Pfizer and Concert Pharmaceuticals battling it out

Concert Pharmaceuticals

With Aclaris now out of the picture, and the race to bring the first ever Alopecia Areata, Totalis and Universalis treatment to market that is FDA-licensed (and hopefully MHRA-approved, the MHRA being the UK equivalent of the FDA – America’s medical regulatory board) reaching its latter stages, two clear competitors have emerged.

Pfizer and Concert Pharmaceuticals are now the two leading pharmaceutical companies left with hats in this particular hair loss ring, and both have promising-looking propositions.

Pfizer

Pfizer is currently in Phase 3 trials for JAK inhibitor treatments for both adults and adolescents, from 12 years of age, with all forms of Alopecia, whilst Concert is preparing to enter the Phase 3 stage, having recently announced positive findings from its Phase 2 trials of over 18s.

The FDA is working closely with both companies, having awarded Concert Pharmaceuticals Fast Track status for its CTP-543 candidate, and granted Pfizer Breakthrough status for its PF-06651600 drug.

There are currently no officially recognised treatments for this condition and, whilst the scalp-only form has both Alopecia Areata treatment course options and tends to right itself naturally within up to 12 months, Alopecia Totalis and Universalis in adults and all forms in children have little in the way of safe and effective therapies available – yet.


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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There are many well-established links between physical health and mental health; even on a basic level, the endorphins released as a result of exercise are known to improve our mood, our sleep and reduce stress – a known culprit behind many hair loss conditions.

Now an Australian study has looked specifically at the relationship between the effects of physical activity levels and the psychological well-being of people with hair loss caused by the chronic autoimmune disorder Alopecia Areata (AA).

exercise mental health feet trainers sneakers physical activitiy happy

This research follows a number of reports detailing how people with any form of Alopecia Areata have a higher risk of developing anxiety and depression.

Patients completed questionnaires

The study authors, from various institutions across Melbourne, note the specificity of this study was necessary due to the fact that “physical activity (PA) has been associated with better mental health outcomes in diverse populations [however] the association in individuals with AA has not been established. The aim of this study was to examine the associations between PA and mental health outcomes in individuals with AA to inform intervention strategies for this specific population.”

The team’s methodology involved a cross-sectional study conducted among 83 participants aged 40.95 ± 13.24 years who had lost more than half the hair on their scalp.

Each volunteer completed authorised International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Depression and Anxiety Stress Scale (DASS-21) questionnaires before their results were analysed to determine associations between physical activity levels and mental health outcomes.

When analysing the findings, researchers found that 81.9 per cent of these respondents did not meet guidelines – presumably Australian government guidelines though this is not stated – for physical activity.

Less physical activity linked to depression and anxiety

Results showed a clear correlation between the participants who did not meet physical activity guidelines and an increased propensity towards severe depression, moderate anxiety and mild stress.

Therefore, researchers concluded this suggests “increased PA participation in AA individuals with severe hair loss is associated with improved mental health status. Intervention efforts for this specific population should consider barriers and enablers to PA participation as they face challenges that differ from the general population.”

Life wait for storm dance in the rain quote inspirational

In the UK, the NHS gives the following advice on the amount of exercise adults aged 19 to 64 need to do, per week, in addition to advising all long periods of sitting are broken up with light activity:

“…at least 150 minutes of moderate aerobic activity such as cycling or brisk walking every week and strength exercises on 2 or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms)
Or: 75 minutes of vigorous aerobic activity such as running or a game of singles tennis every week and strength exercises on 2 or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms)
Or: a mix of moderate and vigorous aerobic activity every week – for example, 2 x 30-minute runs plus 30 minutes of brisk walking equates to 150 minutes of moderate aerobic activity and strength exercises on 2 or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms)…”

Group classes or team sports can also provide a valuable sense of camaraderie, as a number of amateur and professional sports people with Alopecia Areata have found. Famous examples include English rugby player Heather Fisher, footballer Jonjo Shelvey, basketball player Charlie Villanueva and former Olympian cyclist, Joanna Rowsell-Shand, who are all bald due to the more extreme Alopecia phenotypes.

These include Alopecia Totalis and Alopecia Universalis and, although Alopecia Areata treatment is possible for the scalp-only form, these more extensive iterations – which cause baldness to the head and from head-to-toe, respectively – currently have low success-rates for the limited hospital-based treatments available.

Whilst becoming an Olympic-level gold-medallist isn’t feasible for everyone, small steps every day can be beneficial to both mind and body – and especially so to those already known to be more prone to mental health issues.


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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An oral treatment for all forms of the autoimmune disorder Alopecia Areata which causes varying amounts of hair loss, from bald spots on the scalp to complete baldness from head to toe, has reported great progress.

CTP-543, an investigational selective JAK inhibitor which specifically targets Janus kinases JAK 1 and JAK 2, is being developed by Concert Pharmaceuticals and has been granted Fast Track designation by the FDA.

On Tuesday 3rd September 2019 the topline results were released from the latest CTP-543 Phase 2 trial, during which higher doses were explored; the results have been welcomed as “highly encouraging” by hair loss specialists, including Dr. Brett King, Associate Professor of Dermatology at the Yale School of Medicine in America, who is known for his work in the area of JAK inhibition.

Robust results for both safety and efficacy

CTP-543 is a modified version of the JAK inhibitor rhuematoid arthritis drug, ruxolitinib (brand name: Jakafi), and has previously been trialled at lower doses.

This time 149 patients with a confirmed diagnosis of any form of Alopecia Areata, from the scalp-only phenotype to the more extensive Alopecia Totalis and Alopecia Universalis, which also involve the loss of facial and body hair, were given either 8mg of CTP-543 twice a day, 12mg of CTP-543 twice per day, or a placebo twice each day.

Results show “statistically significant differences” for both the 8mg and 12mg doses when compared to the placebo results, according to a Concert press release and data – as well as hair regrowth progress photos – which can be seen by clicking on the image below.

Concert Pharmaceuticals CTP-543 Alopecia Areata Treatment drug Phase 2 Trial Results 8mg 12mg doses

The average amount of hair loss in each patient at the start – their baseline measurement – was 88 per cent (where 100 per cent is total baldness).

The groups where 8 mg or 12 mg were administered twice each day saw far more patients achieve hair regrowth of over 75% and over 90% than the placebo group, at the 24 week mark. This was measured by improvements seen in their Severity of Alopecia Tool (SALT) score but was also reflected in patients own reporting via the Patient Global Impression of Improvement Scale data.

This information comes from the trial’s topline results, with complete study results expected to be presented in the near future.

In terms of safety and tolerability, the press release advises that both doses were generally well-tolerated. Of the five participants who discontinued the trial, three were taking the placebo and two were taking 8mg doses – none were taking the 12mg twice-per-day dosage.

Concert reports on adverse events during the trial, as follows:

“The most common (≥10%) side effects in the 12 mg CTP-543 dose group were headache, nasopharyngitis, upper respiratory tract infection, and acne. One serious adverse event of facial cellulitis was reported as possibly related to treatment; however, after a brief interruption, treatment was continued and this patient completed the trial. No thromboembolic events were reported during the trial.”

Preparing for Phase 3 trials with FDA guidance

James V. Cassella, Ph.D., Concert’s Chief Development Officer said of the news, “We are very pleased with these clinical results and continue to believe CTP-543 has potential to be a best-in-class treatment for alopecia areata… We are highly focused on the need for an effective and safe treatment for alopecia areata, and we plan to advance CTP-543 into Phase 3 testing next year.”

Indeed the next steps include preparing to talk to the FDA about CTP-543 Phase 2 end-point data and what the regulatory body wants to see from Phase 3 trials so these can be properly structured.

Concert stated they may consider looking at once a day dosing versus twice a day doses as having a strong efficacy and safety profile is the company’s main concern, which would also be likely to lead to a regulatory advantage.

In a follow-up phone call to discuss these findings, Concert’s representatives advised they are not planning on testing higher doses, though did note that many of the trial participants, especially from the 12mg CTP-543 cohort, have opted to continue treatment, and monitoring.

Therefore, they believe it is possible that this longer duration of treatment may increase the response rate of the current dosages – 8 and 12 mg.

In terms of Pfizer cross-trial comparisons, given Pfizer is the other front-runner when it comes to using JAK inhibitors to treat Alopecia Areata since Aclaris dropped out of the race – Concert was confident their work stacked up well, stating:

“We believe trial data is as strong as Pfizer’s. The 75 per cent change and 90 per cent change from baseline – we offer real benefit and have robust results compared to the data Pfizer has released.”

Whilst Alopecia Areata treatment can currently be beneficial for adults with the scalp-only form, there are no MHRA-licensed nor FDA-approved hairloss solutions for any of its iterations, and the more extensive they are, the lower the success rates tend to be. This is why the FDA in particular is lending its weight to helping bring about a safe and effective treatment to address this unmet need.


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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